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  1. Ng SY, Chong SY
    Med J Malaysia, 2014 Dec;69(6):252-6.
    PMID: 25934954 MyJurnal
    Study site: Hospital Teluk Intan, Perak, Malaysia
  2. Teh CS, Jayalakshmi P, Chong SY
    Ear Nose Throat J, 2014 Sep;93(9):E22-5.
    PMID: 25255354
    We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients-14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n = 17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.
  3. Teh CS, Chong SY
    Med J Malaysia, 2011 Aug;66(3):264-5.
    PMID: 22111456 MyJurnal
    A 33-year-old Malay lady presented to us with 1-month history of globus sensation in the throat. Clinically, she had a 3cmx2cmx1cm sessile soft mass arising from the right tongue base and was treated as hypertrophied lingual tonsil. Biopsy of the mass was done when the patient developed bleeding and was reported as diffuse non-Hodgkin's B-cell lymphoma. Globus sensation is a common complaint in the ORL clinic. It is important to be able to decide if further investigation is warranted to differentiate a malignant from a benign lesion as at times, a malignant lesion can masquerade as a harmless lesion.
  4. Chong SY, Chong LA, Ariffin H
    Am J Emerg Med, 2010 Jun;28(5):603-6.
    PMID: 20579557 DOI: 10.1016/j.ajem.2009.02.006
    The aim of this study is to formulate an accurate estimate of the spinal needle depth for a successful lumbar puncture in pediatric patients.
  5. Ng SY, Begum S, Chong SY
    Pediatr Dermatol, 2016 Mar;33(2):160-4.
    PMID: 26856694 DOI: 10.1111/pde.12758
    Atopic eczema (AE) is a common chronic inflammatory skin disorder in children, with emollients and topical corticosteroids (TCSs) commonly prescribed as treatment. There is no published guidance on the correct order of application of emollient and TCS in children with AE.
  6. Chong SY, Lim TB, Seow LL
    Malaysian Dental Journal, 2008;29(2):97-103.
    MyJurnal
    Objectives: The objectives of the study were to assess: i) the staining susceptibility of composite resins, ii) the ability of whitening toothpastes in removing stains from composite resins.
    Materials and Methods: Thirty specimens from each composite resins: Filtek Z350 (3M ESPE), Filtek Z250 (3M ESPE) and Beautifil (Shofu Inc.) were fabricated. After polishing, specimens were immersed in coffee for 3 days. Specimens were then brushed twice a day for 2 weeks using Colgate Total (Colgate-Palmolive, control group), Colgate Advanced Whitening (Colgate- Palmolive, test group) and Darlie All Shiny White (Hawley & Hazel Chemical Co., test group). Colour changes (?E*) were measured using Spectrophotometer at baseline, after coffee immersion and after brushing. Results were statistically analyzed using one way ANOVA and Tukey’s test.
    Results: There was significant difference in terms of colour changes for Filtek Z350, Filtek Z250 and Beautifil after coffee immersion (P0.05).
    Conclusions: Filtek Z350 was able to resist staining by coffee better than Filtek Z250 and Beautifil. The whitening toothpastes did not offer added advantage in terms of ability to remove stains compared to ordinary toothpaste.
  7. Chong SY, Azmi AA, Cheah YK
    Data Brief, 2023 Dec;51:109657.
    PMID: 37876741 DOI: 10.1016/j.dib.2023.109657
    Barrientosiimonas humi gen. nov., sp. nov. 39T is a rare actinobacteria strain isolated from the less explored extreme environment of the Antarctic soil. Here, we present the whole genome sequencing and annotation data from the high-quality draft genome of B. humi from Antarctica. The extracted genomic deoxyribonucleic acid (DNA) was sequenced using the PacBio Sequel sequencing platform, followed by the Illumina HiSeq sequencing system. Subsequently, the assembly data from Canu 1.7 and Pilon were subjected to bioinformatics analysis for genome annotation to analyze the entire genomic information of the sequences. Different bioinformatics analysis approaches were used to disclose a high-quality draft genome basis for B. humi and provided a better understanding of its biological and molecular functions. Note that 83,639 reads were predicted from its 3.6Mb genome size, with a guanine-cytosine content (GC) content of 72.39%. The genome was assembled into two contigs, where the larger contig represents the chromosome and the smaller contig represents the plasmid. It is composed of 3,381 coding genes, with about 95% of them being functionally annotated. It consists of 3,318 coding sequences, one tmRNA gene, 57 tRNA genes, and five repeated regions. B. humi was evident, sharing a close sequence similarity with the species Demetria terragena and the family Dermacoccaceae. Gene Ontology (GO) functional classification indicated cell and cell parts were highly represented among the cellular component category; catalytic activity and binding were the most enriched processes within the molecular function category; metabolic and cellular processes were the most represented in the biological process category. Clusters of Orthologous Group (COG) functional classification revealed metabolism-related genes were highly enriched and mostly mapped to amino acid transport metabolism, transcription, energy production, and conversion. Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) functional classification reported that the metabolism process was the most represented KEGG pathway. There were 52 biosynthetic gene clusters involved in secondary metabolites biosynthesis, indicating B. humi has antibacterial, antifungal, cytotoxic, and inhibitor bioactivities. The dataset of the whole-genome sequence of B. humi has been deposited in the European Nucleotide Archive (ENA) repository under the accession number PRJEB44986 / ERP129097. The dataset of the genome annotation of B. humi had been deposited in Zenodo. The reported genomic sequence data for B. humi contributes comprehensive data to the current molecular information of the species, serving as a significant approach that facilitates the advancement of medicine.
  8. Chong SY, Danaee M, Ganesan D
    Asian Spine J, 2023 Jun;17(3):538-548.
    PMID: 36740928 DOI: 10.31616/asj.2022.0293
    STUDY DESIGN: Validation of a novel retrospective comparative questionnaire to obtain post-intervention outcome data in patients with lumbar degenerative spinal disease.

    PURPOSE: Acquiring prospective outcome data for spinal intervention is not frequently feasible in resource-depleted units in certain developing countries. Therefore, a novel retrospective instrument is being validated for clinical use, which can act as a standard method to describe outcomes when data are retrospectively collected.

    OVERVIEW OF LITERATURE: The standard method of collecting outcome data after a spinal intervention has been prospective, including the Oswestry Disability Index, Roland-Morris Questionnaire, and Short Form-36. The process of content validation and reliability of the novel retrospective spinal questionnaires is highlighted.

    METHODS: Questionnaire items were created based on a literature review, followed by a process of content validation by experts and modification based on expert opinions to achieve an acceptable content validity index (CVI, 0.70-1.00). To calculate factor loadings for each question, a pilot test was subsequently conducted from a pool of patients who underwent lumbar spine surgeries for degenerative spine diseases.

    RESULTS: All items achieved a CVI of >0.85 for both relevancy and clarity and were successfully validated after appropriate corrections were made before the second validation phase. Except for Q9 and Q10, which showed low-loading factors in the pooled sample, the remainder of the items had acceptable loading factors across different subgroups, indicating that the passage of time did not affect the results of the exploratory factor analysis.

    CONCLUSIONS: The retrospective questionnaire that encompasses the general well-being and lumbar-specific symptoms is a valid and reliable instrument to provide an impression of the outcome after intervention in a patient with a degenerative lumbar spinal disease. A summative score will indicate the overall outcome.

  9. Chong SY, Tiňo P, He J, Yao X
    Evol Comput, 2019;27(2):195-228.
    PMID: 29155606 DOI: 10.1162/evco_a_00218
    Studying coevolutionary systems in the context of simplified models (i.e., games with pairwise interactions between coevolving solutions modeled as self plays) remains an open challenge since the rich underlying structures associated with pairwise-comparison-based fitness measures are often not taken fully into account. Although cyclic dynamics have been demonstrated in several contexts (such as intransitivity in coevolutionary problems), there is no complete characterization of cycle structures and their effects on coevolutionary search. We develop a new framework to address this issue. At the core of our approach is the directed graph (digraph) representation of coevolutionary problems that fully captures structures in the relations between candidate solutions. Coevolutionary processes are modeled as a specific type of Markov chains-random walks on digraphs. Using this framework, we show that coevolutionary problems admit a qualitative characterization: a coevolutionary problem is either solvable (there is a subset of solutions that dominates the remaining candidate solutions) or not. This has an implication on coevolutionary search. We further develop our framework that provides the means to construct quantitative tools for analysis of coevolutionary processes and demonstrate their applications through case studies. We show that coevolution of solvable problems corresponds to an absorbing Markov chain for which we can compute the expected hitting time of the absorbing class. Otherwise, coevolution will cycle indefinitely and the quantity of interest will be the limiting invariant distribution of the Markov chain. We also provide an index for characterizing complexity in coevolutionary problems and show how they can be generated in a controlled manner.
  10. Gan CS, Chong SY, Lum LC, Lee WS
    Singapore Med J, 2013 Feb;54(2):e35-7.
    PMID: 23462840
    An eight-month-old female infant with severe dengue disease, who was repeatedly given therapeutic paracetamol for severe dengue, developed fulminant liver failure with encephalopathy, gastrointestinal haemorrhage and severe coagulopathy. She responded to supportive measures and N-acetylcysteine infusion. This case highlights the potential danger of administering repeated therapeutic doses of paracetamol in childhood severe dengue disease with hepatitis.
  11. Shashinder S, Tang IP, Velayutham P, Prepageran N, Gopala KG, Kuljit S, et al.
    Med J Malaysia, 2009 Mar;64(1):31-3.
    PMID: 19852317 MyJurnal
    To review the demographics, management and outcome of patients undergoing parotidectomy at a tertiary center. A total of 76 patients who underwent parotidectomies from January 1996 to December 2005 at the ORL department of our center were reviewed. All clinical, operative, postoperative, histology data were gathered and reviewed. Fine-needle aspiration cytology (FNAC) was diagnostic in 90% of patients with a sensitivity of 76% and specificity of 96%. Twenty-one patients had malignant tumours and the rest had benign or inflammatory lesions. There were a total of 48 superficial and 28 total parotidectomies performed. Facial nerve palsy occurred in 30 (39%) patients with 4% permanent palsy and 35% temporary palsy. The recurrence rate of pleomorphic adenoma was 2.6%. FNAC and CT scan were performed prior to the surgery were useful guidance in planning the operation but clinical judgment is more important. The most common surgery performed was superficial parotidectomy and the most common cause was due to pleomorphic adenoma. The incidence of complications and recurrence of tumour are comparable to other international studies. Prior knowledge of anatomy and careful planning is needed to decrease the incidence of facial nerve palsy.
  12. Lee WS, Teo KM, Ng RT, Chong SY, Kee BP, Chua KH
    Gene, 2016 Jul 15;586(1):1-6.
    PMID: 27050310 DOI: 10.1016/j.gene.2016.03.049
    Trichohepatoenteric syndrome (THES) is a rare autosomal recessive disorder that is classically associated with intractable diarrhea with an onset within the first few months of life. Herein, we investigated and reported novel mutations in two causal genes in 3 Malaysian cases. Genomic DNA was extracted from peripheral blood obtained from patients in two Malaysian Chinese families. The exons of SKIV2L and TTC37 genes were amplified and sequenced by bi-directional sequencing to identify the point mutations within the coding sequence. Three Chinese boys from two families with characteristic features and clinical course were diagnosed with THES. In family-1, two point mutations were identified in the SKIV2L gene (c.1891G>A and c.3187C>T). In family-2, a single-nucleotide duplication (c.3426dupA) was found in the TTC37 gene. These mutations cause the production of abnormal non-functional gene product leading to the clinical manifestations in the patients. We reported three point mutations, which have not been previously described in other patients with THES in SKIV2L and TTC37 genes, including one nonsense, one frameshift, and one missense mutations.
  13. Chong SY, Fhun LC, Tai E, Chong MF, Sonny Teo KS
    Cureus, 2018 Jan 24;10(1):e2109.
    PMID: 29581921 DOI: 10.7759/cureus.2109
    Yoga has recently been touted as a means to improve physical and mental well-being. However, no form of exercise is without its risks. A 32-year-old Chinese female with moderate myopia complained of right eye sudden onset of floaters and mild blurring of vision after the head-down posture. The visual acuity was 6/12 in the right eye and 6/9 in the left eye. A right eye fundus examination showed posterior vitreous detachment, with a small blood clot located at the inferior margin of the optic disc. The patient was diagnosed with right eye vitreous hemorrhage secondary to acute posterior vitreous detachment and was managed conservatively. Acute changes in posture, especially between an upright and a head-down position, may cause acute posterior vitreous detachment. As yoga practitioners may be required to assume this head-down position, myopic patients should be warned of the possible ocular complications of this exercise.
  14. Penkunas MJ, Chong SY, Rhule ELM, Berdou E, Allotey P
    Global Health, 2021 06 21;17(1):63.
    PMID: 34154605 DOI: 10.1186/s12992-021-00714-3
    Efficacious health interventions tested through controlled trials often fail to show desired impacts when implemented at scale. These challenges can be particularly pervasive in low- and middle-income settings where health systems often lack the capacity and mechanisms required for high-quality research and evidence translation. Implementation research is a powerful tool for identifying and addressing the bottlenecks impeding the success of proven health interventions. Implementation research training initiatives, although growing in number, remain out of reach for many investigators in low- and middle-income settings, who possess the knowledge required to contextualize challenges and potential solutions in light of interacting community- and system-level features. We propose a realigned implementation research training model that centers on team-based learning, tailored didactic opportunities, learning-by-doing, and mentorship.
  15. Lee GW, Chew KS, Wong SY, Chong SY, Ong SY, Lee WS
    J Paediatr Child Health, 2022 Nov;58(11):1972-1979.
    PMID: 35880617 DOI: 10.1111/jpc.16130
    AIM: Quality of life (QoL) in children with inflammatory bowel disease (IBD) is often impaired by underlying disease. We evaluated factors affecting health-related QoL (HRQoL) in Malaysian children with IBD.

    METHODS: A cross-sectional study using IMPACT-III questionnaires evaluating HRQoL in children aged 8-17 years with duration of IBD of ≥6 months was conducted. IMPACT-III, a validated instrument designed to measure HRQoL in children with IBD, was used. Higher IMPACT-III (maximum = 100) score indicates better HRQoL. Impact of socio-demographic and clinical factors of IBD on the HRQoL was evaluated. Paediatric Crohn's disease (CD) and ulcerative colitis (UC) activity indices were used to classify disease severity.

    RESULTS: A total of 75 children (UC = 44, CD = 41; mean (SD) age at diagnosis 8.2 (3.5) years) were interviewed at mean age of 12.8 (2.7) years. Mean IMPACT-III score was significantly lower in children with more severe disease (mild: 71.8 (13.6) vs. moderate: 65.5 (10.9) vs. severe: 46.3 (14.5); P 

  16. Lee WS, Lum SH, Lim CB, Chong SY, Khoh KM, Ng RT, et al.
    Hepatol Int, 2015 Apr;9(2):292-302.
    PMID: 25788179 DOI: 10.1007/s12072-014-9558-0
    BACKGROUND: Little is known about autoimmune liver disease (AILD) in Asian children. We studied the clinical features and predictors of outcome in childhood AILD in an Asian population.

    METHODS: Retrospective review of AILD [autoimmune hepatitis type 1 and 2 (AIH1, AIH2), primary sclerosing cholangitis (PSC) and autoimmune sclerosing cholangitis (ASC)] seen at two pediatric liver units in Malaysia.

    RESULTS: At presentation, 17 (56%) of the 32 children [19 females, 59%; median (range) age 7.7 (1.8-15.5) years] with AILD (AIH1 = 18, AIH2 = 5, PSC = 0, ASC = 9) had liver cirrhosis. At final review [median (range) duration of follow-up 4.8 (0.4-12) years], 24 patients (75%) survived with a native liver. Twenty-one (66%) were in remission; 19 (AIH1 = 11; AIH2 = 4, ASC = 4) were on prednisolone and/or azathioprine, one on cyclosporine and another on mycophenolate mofetil. Three (AIH1 = 3) were in partial remission. Of the two who underwent liver transplantation (LT; 6.5%; both ASC), one died of primary graft failure after LT. Six patients (19%) died without LT (acute liver failure, n = 1; end-stage liver disease, n = 5). The overall survival rate (native liver and survival post-LT) was 78%. A delay in seeking treatment adversely affected the final outcome [survival with native liver vs. LT or death (duration between onset of disease and treatment; median ± standard error) = 2.5 ± 2.9 months vs. 24.0 ± 13.3 months; p = 0.012].

    CONCLUSIONS: Although remission was achieved in the majority of patients with prednisolone and/or azathioprine therapy, delay in seeking diagnosis and treatment adversely affects the outcome of childhood AILD in Malaysia.
  17. Lee YY, Hassan SA, Ismail IH, Chong SY, Raja Ali RA, Amin Nordin S, et al.
    J Paediatr Child Health, 2017 Dec;53(12):1152-1158.
    PMID: 29205651 DOI: 10.1111/jpc.13640
    The role of gut microbiota in early life and its impact on gut health and subsequent diseases remain unclear. There is a lack of research and awareness in this area, especially in the Asia-Pacific region, including Malaysia. This paper reports the position of a Malaysian Working Group on some key issues surrounding gut microbiota in early life and its role in gut health and diseases, as well as experts' stand on probiotics and prebiotics. The group reached a consensus that certain factors, including elective caesarean; premature deliveries; complementary feeding; use of antibiotics, prebiotics and/or probiotics; and exposure to the external environmental, have an impact on gut microbiota in early life. However, as evidence is lacking, especially from the Asia-Pacific region, further studies are needed to understand how gut microbiota in early life affects subsequent diseases, including allergy, inflammatory bowel disease, obesity and infantile colic. Lastly, although beneficial in acute diarrhoeal disease and probably allergic eczema, probiotics (and/or prebiotics) should be used cautiously in other gut dysbiotic conditions until more data are available.
  18. Muhardi L, Aw MM, Hasosah M, Ng RT, Chong SY, Hegar B, et al.
    Front Pediatr, 2021;9:778747.
    PMID: 35071132 DOI: 10.3389/fped.2021.778747
    Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0-5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0-6 months, the reported prevalence of colic ranged between 10-15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0-12 months, the reported prevalence of regurgitation and constipation were 3.4-25.9% and 1.3-17.7%, respectively. The reported prevalence of constipation was 1.3-26% among children aged 13-48 months and 13% among children aged 4-18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.
  19. West LN, Zakharova I, Huysentruyt K, Chong SY, Aw MM, Darma A, et al.
    Nutrients, 2022 Sep 30;14(19).
    PMID: 36235719 DOI: 10.3390/nu14194067
    Background: The prevalence of functional constipation (FC) among children varies widely. A survey among healthcare professionals (HCPs) was conducted to better understand the HCP-reported prevalence and (nutritional) management of FC in children 12−36 months old. Methods: An anonymous e-survey using SurveyMonkey was disseminated via emails or WhatsApp among HCPs in eight countries/regions. Results: Data from 2199 respondents were analyzed. The majority of the respondents (65.9%) were from Russia, followed by other countries (Indonesia (11.0%), Malaysia (6.0%)), Mexico, KSA (5.1% (5.7%), Turkey (3.0%), Hong Kong (2.2%), Singapore (1.1%)). In total, 80% of the respondents (n = 1759) were pediatricians. The prevalence of FC in toddlers was reported at less than 5% by 43% of the respondents. Overall, 40% of the respondents reported using ROME IV criteria in > 70% of the cases to diagnose FC, while 11% never uses Rome IV. History of painful defecation and defecations < 2 x/week are the two most important criteria for diagnosing FC. In total, 33% of the respondents reported changing the standard formula to a specific nutritional solution, accompanied by parental reassurance. Conclusion: The most reported prevalence of FC in toddlers in this survey was less than five percent. ROME IV criteria are frequently used for establishing the diagnosis. Nutritional management is preferred over pharmacological treatment in managing FC.
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